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Statewide Implementation of Electronic Health Records. EHRs in Massachusetts: Who has them and how are they using them? Supported by the Agency for Healthcare Research and Quality. Outline. Background: Massachusetts e-Health Collaborative Two statewide surveys Office practice managers

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Statewide Implementation of Electronic Health Records

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Statewide Implementation of Electronic Health Records

  • EHRs in Massachusetts: Who has them and how are they using them?

  • Supported by the

  • Agency for Healthcare Research and Quality

© 2006 Steven R. Simon, MD All Rights Reserved


Outline

  • Background: Massachusetts e-Health Collaborative

  • Two statewide surveys

  • Office practice managers

  • Physicians in office practices

© 2006 Steven R. Simon, MD All Rights Reserved


Massachusetts e-Health Collaborative (MAeHC)

  • Formed in 2004

  • Major health care stakeholders

  • $50 million from Blue Cross Blue Shield of MA

  • Statewide EHR adoption

  • Demonstration project:

    • Universal EHR adoption in 3 communities

    • Intra-community and inter-community data exchange

© 2006 Steven R. Simon, MD All Rights Reserved


EHR Adoption in U.S., 2003

  • Most physicians do not currently use EHRs

    • National average 17.6% of physicians using EHRs

  • Large groups more likely to use EHRs than small groups

  • HMO-owned practices are three times more likely than physician-owned practices to use an EHR

* Burt and Sisk. Health Affairs. Sep/Oct 2005.

© 2006 Steven R. Simon, MD All Rights Reserved


What is Current State of EHR Adoption in Massachusetts?

  • Two statewide surveys, summer 2005

  • Office practice managers

  • Physicians in office practices

© 2006 Steven R. Simon, MD All Rights Reserved


Office Practice Survey

  • Stratified sample of 1829 practices

    • (30% of state)

  • All specialties, urban/rural, large and small practices

  • 1-page mailed survey sent to the attention of office practice managers

  • 46% response rate

© 2006 Steven R. Simon, MD All Rights Reserved


© 2006 Steven R. Simon, MD All Rights Reserved


Implementation – Future Plans

Within the next 12 months (13%)

Not in the foreseeable future (52%)

Within the next 1-2 years (24%)

Within 3-5 years (11%)

© 2006 Steven R. Simon, MD All Rights Reserved


Barriers to Implementation*

© 2006 Steven R. Simon, MD All Rights Reserved


Physician Survey

Same sample of practices as office manager survey

Included only physicians with ambulatory clinical practices

8-page mail survey

$20 incentive

© 2006 Steven R. Simon, MD All Rights Reserved


Overall Response Rate: 71%

© 2006 Steven R. Simon, MD All Rights Reserved


EHR Adoption

© 2006 Steven R. Simon, MD All Rights Reserved


EHR Adoption

© 2006 Steven R. Simon, MD All Rights Reserved


Incentives

Moderate/Extensive

Yes

Percent with EHR

Yes

No

Limited/None

No

© 2006 Steven R. Simon, MD All Rights Reserved


Additional Adoption Statistics

  • On a physician level, a total of 45 percent of physicians in Massachusetts had EHRs.

  • Among practices with EHRs, more than half (53 percent) reported having EHRs in their practice for more than 3 years.

© 2006 Steven R. Simon, MD All Rights Reserved


Practice characteristics as correlates of EHR Adoption

© 2006 Steven R. Simon, MD All Rights Reserved


Office computing capabilities as correlates of EHR adoption in ambulatory care

© 2006 Steven R. Simon, MD All Rights Reserved


Perceived barriers to adoption or expansion of HIT as correlates of EHR adoption in ambulatory care

© 2006 Steven R. Simon, MD All Rights Reserved


Organizations influencing practices in the decision whether to adopt a new EHR system

© 2006 Steven R. Simon, MD All Rights Reserved


Limitations

  • Massachusetts only

  • New measure of EHR usage (may not be comparable to other studies)

  • Cross-sectional: difficult to draw causal inference

© 2006 Steven R. Simon, MD All Rights Reserved


Conclusions

  • Fewer than one in four office practices in MA have EHRs

  • Nearly 50% of physicians in MA have EHR in their practice

  • Larger practices and hospital-based practices were more highly correlated with EHR adoption

© 2006 Steven R. Simon, MD All Rights Reserved


Conclusions (2)

  • For practices without EHRs, >80% report finances as major barrier

  • Both financial and non-financial (e.g., cultural) barriers persist

  • EHR decision-making is local  Implications for interventions

© 2006 Steven R. Simon, MD All Rights Reserved


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